Comparison of anatomic and non‐anatomic hepatic resection for hepatocellular carcinoma

Abstract

Background The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC). Methods To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor. Results Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS. Conclusions Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.

Obesity and recurrence‐free survival in patients with hepatocellular carcinoma after achieving sustained virological response to interferon therapy for chronic hepatitis C

“…Non‐anatomical resection was also an independent risk factor for HCC recurrence. Anatomical resection along the portal tributaries is considered an effective way to remove occult intrahepatic HCC metastases . In the present study, the patients who underwent anatomical resection had no multiple recurrences near the resection site.…”

Accuracy of actual resected liver volume in anatomical liver resections guided by 3‐dimensional parenchymal staining using fusion indocyanine green fluorescence imaging

“…Therefore, ALR can decrease intraoperative bleeding as well as the risk of postoperative infection and bile leakage . (2) Regarding primary liver lesions below 5 cm, ALR can reduce the risk of intrahepatic relapse and improve overall survival . Therefore, ALR is an essential method for malignant tumors of the liver.…”

“…Anatomical liver resection (ALR), which can remove the tumor completely, reduce intraoperative bleeding and injury, and preserve maximum liver function, is an essential treatment tool for malignant tumors of the liver. Evidence suggests that anatomic resection in hepatocellular carcinoma and hilar cholangiocarcinoma improves survival . Methods to ensure accurate resection scope are of utmost importance in ALR.…”

Anatomic resection and wide resection margin play an important role in hepatectomy for hepatocellular carcinoma with peritumoural micrometastasis

“…The mainstream view holds that anatomic resection is superior to local resection, which can reduce intrahepatic metastasis of tumour cells through portal vein and other blood vessels. During anatomic resection, the exposure of hepatic vein can prevent accidental bleeding and vascular injury, as well as reduce the incidence of post‐operative complications . Although computer simulation technology and liver staining technique are available, the actual operation still demands heavily on a surgeon's subjective judgement.…”

“…During anatomic resection, the exposure of hepatic vein can prevent accidental bleeding and vascular injury, as well as reduce the incidence of post-operative complications. 13,14 Although computer simulation technology and liver staining technique are available, the actual operation still demands heavily on a surgeon's subjective judgement. Consequently, results of anatomic resection are highly affected by surgeons' surgical skills, anatomical knowledge, the actual development of procedure and the way to deal with remnant liver margin.…”